中晚期鼻咽癌后程超分割放疗的临床观察

Late late course hyperfracfionated radiotherapy for advanced and moderately advanced nasopharyngeal carcinoma

目的 探讨鼻咽癌后程超分割（LCF）放疗的疗效和F副反应。方法 182例中晚期鼻咽癌随机分为常规分割（CF）放疗组92例和LCF组90例。CF组鼻咽部和颈部全程给予根治剂量65-75Gy，45-55d完成。LCF组鼻咽部采用常规放疗36Gy3．5周后改为LCF，即1．2-1．3Gy／次，2次／d（间隔6-8h），剂量30-35Gy，3．0-4．0周完成；颈部分割方法同cF组。鼻咽部总剂量为65-75Gy，6．5-7．5周完成；有颈部淋巴结转移者照射至68-74Gy，临床上未扪及淋巴结者预防照射至55-60Gy。结果治疗结束时肿瘤完全消失、缩小和无效者cF组分别为51％、36％和13％，LCF组分别为67％、29％和4％（Х^2=4．20，P〈0．05）。LCF组1、3年生存率分别为96％、78％，优于CF组的91％、74％（Х^2=8．24，P=0．004），尤其对Ⅳ期病例LCF较cF具有更好的疗效。1、2级和≥3级急性放射反应发生率CF组分别为38％、42％、20％，LCF组分别为28％、44％、28％（Х^2=1．70，P〉0．05）。结论 后程超分割放疗较常规放疗提高鼻咽癌患者近期疗效及1、3年生存率，而未增加急性放疗副反应。

Objective To study the response and side-response of late course hyperfractionated radiotherapy（LCF） for moderately advanced and advanced nasopharyngeal carcinoma （NPC）. Methods 182 patients with the above carcinoma were randomized into conventional fractionation（CF） （92 patients） with a total dose of 65-75 Gy,and 90 patients in LCF group were treated with the same fractionation as CF group to the dose of 36 Gy, then followed by LCF , to a total dose of 65-75 Gy. The neck region of the patients who was negative for involved cervical lymph node were prophylactic irradiation to the total dose of 55- 60 Gy in 5.5-6.0 weeks. Results The complete response rate was 67% in LCF group and 51% in CF group after radiotherapy（ Х^2 = 4.20,P 〈 0. 05 ）. The 1-,3-year overall survival rate was 96%, 78% in LCF group,with 91% ,74% in the CF group（Х^2 = 8.24,P =0. 004）. The 1-,2- and ≥3-grade acute side-response rate was 38% ,42% and 20% in the CF group, with 28% ,44% and 28% in the LCF group（ Х^2 = 1.70,P 〉 0. 05 ）. Conclusions The local control rate of moderatedly advanced and advanced NPC treated LCF radiotherapy is superior to CF. LCF radiotherapy is well tolerated and does not increase the acute sideresponse, and ,therefore, LCF could improve the 1-,3-year survival rates of moderately advanced and advanced NPC with radiotherapy.